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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AV ENUE - STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 44 2! 4-P E. LI RE)a-ry r21'› . crryfzip 6,9-7.-7 1 SaP.32. <br />CROSS STREET A1 • C11S-12-0KEE APN 0o,c-- 3, 0 - 3 I PARCEL SIZE /:1 2- Ar . <br />OWNER NAME ) e•-k-F 4 Air`Wc-,1 C tferPill'A A) PHONE 3 21-33 41 <br />OWNER ADDRESS / 4 -it ev_ t...P..) • CITY/STATE/ZIP 6'6 LT, C4't q vi,3 2.. <br />CONTRACTOR E 0 et 14 &E4G-0 m 04 E-A/Ttri- PHONE 3(.9.- oric <br />CONTRACTOR ADDRESS 0 —7 kL) - 0 Ale- c-r. crryisTATE/zip Lai> I 1 ti cl <br />LICENSE C-42 :C-36 OTHER C NUMBER 7-1 5 I EXPIRAllON DATE 4-1 -3 0- 2-2- <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPUCATION # .7( PERC TEST # <br /> 1 <br />TYPE OF WORK: 0 NEW INSTALLATION <br />Li REPLACEMENT <br />0 REPAIR/ADDITION <br />F.1 OUT-OF-SERVICE SEPTIC SYSTEM <br />0 ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br />INSTALLATION WILL SERVE: E RESIDENCE <br />NUMBER OF LIVING UNITS: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />O <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES 1.-.1 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED Wpm ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM HOUR AE/MCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE pre 0.J . 141 biZ DATE 1 2-0 <br />Application Accepted By Date .342 //O). <br />DEPARTMENT USiE ONLY <br />Area L)J q <br />Employee I D# r)A • <br />Final Inspection By Date 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br /> Pit/Sump Soil Character: <br /> <br />PE <br />Code <br />SC Received <br />INFO <br />( Checyttil Amount <br />Remitted Date Permit/ <br />Service Request # , Invoice # Permit ID# Cash <br />LID,-,a s-.3 (,..1.1.7,- /7c--- *is-.. lititi) Sic20(Iggq6S :SS321(1UV illIS ONSITEWASTEVVATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18